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General NPI Number Information
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NPI Number | 1790217669
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Entity Type | Individual
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Provider Name | TIKLAT ISSA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 4440 E VILLAGE RD
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City | LONG BEACH
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State | CA
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Zip | 90808-1540
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Country | US
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Telephone | 562-425-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 4440 E VILLAGE RD
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City | LONG BEACH
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State | CA
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Zip | 90808-1540
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Country | US
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Telephone | 166-164-5840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 101254
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License Number State | CA
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